<h3 class="frm-title">Personal Details<span>stem #1/5</span></h3>	
<div class="myform">
    <div class="frmrow">
        <div class="col1-3 mr1">
            <label>Student's Last Name:<span>*</span></label>
            <input type="text" name="" value="" class="txtbox frmfname">
        </div>
        <div class="col1-3 mr1">
            <label>Student's Middle Name:<span>*</span></label>
            <input type="text" name="" value="" class="txtbox frmmname">
        </div>
        <div class="col1-3">
            <label>Student's First Name:<span>*</span></label>
            <input type="text" name="" value="" class="txtbox frmlname">
        </div>
        <div class="clrfx"></div>
    </div>

    <div class="frmrow">
        <div class="col1-3 mr1">
            <label>Gender:<span>*</span></label>
            <div class="radioBg">Male<input type="radio" name="gender" value="male" class="txtradio frmmale"></div>
            <div class="radioBg">Female<input type="radio" name="gender" value="female" class="txtradio frmfemale"></div>
        </div>
        <div class="col1-4">
            <label>Nationality:<span>*</span></label>
            <input type="text" name="" value="" class="txtbox frmnationality">
        </div>
        <div class="clrfx"></div>
    </div>
    <div class="frmrow">
        <div class="col1-3 mr1">
            <label>Student's Mobile Number:<span>*</span></label>
            <input type="text" name="" value="" class="txtbox frmmobile">
        </div>
        <div class="col1-3 mr1">
            <label>Alternate Number(Friend):<span>*</span></label>
            <input type="text" name="" value="" class="txtbox frmalternate">
        </div>
        <div class="col1-3">
            <label>Landline Number:<span>*</span></label>
            <input type="text" name="" value="" class="txtbox frmlandline">
        </div>
        <div class="clrfx"></div>
    </div>

    <div class="frmrow">
        <div class="col1-2 mr1">
            <label>Student's Email ID:<span>*</span></label>
            <input type="text" name="" value="" class="txtbox frmemail">
        </div>
        <div class="col1-2">
            <label>Confirm Email Id:<span>*</span></label>
            <input type="text" name="" value="" class="txtbox frmcemail">
        </div>
        <div class="clrfx"></div>
    </div>
    <div class="frmrow">
        <div class="col1-1">
            <label>Permanent Address:<span>*</span></label>
            <input type="text" name="" value="" class="txtbox frmaddress">
        </div>
    </div>

    <div class="frmrow">
        <div class="col1-2 mr1">
            <label>City:<span>*</span></label>
            <input type="text" name="" value="" class="txtbox frmcity">
        </div>
        <div class="col1-2">
            <label>State:<span>*</span></label>
            <select name="" class="txtbox frmstate">
                <option>Select State</option>
            </select>
        </div>
        <div class="clrfx"></div>
    </div>

    <div class="frmrow fl w100">
        <div class="col1-12 tl">Total Affidavits Registered- 672202</div>
        <div class="col1-13 tr">
            <input type="submit" name="" value="Next" class="btnnext">
        </div>
    </div>

</div>